Bone plate with insert(s) for optimally directing fasteners

ABSTRACT

An apparatus is provided for fusing bones of the human body. The apparatus comprises a bone plate which generally is a member having one or more fixation apertures, configured to receive fasteners, and an insert aperture. The bone plate comprises a semi-rigid material, such as a biocompatible metal or Polyetheretherketone (PEEK), possessing a tensile strength suitable for immobilizing bones. A convertible insert is configured to be retained within the insert aperture. The convertible insert is configured to optimally direct a fastener towards a chosen point of purchase for fixating or compressing bones. In some embodiments, the insert is configured to direct a fastener at an oblique angle relative to a plane of the fusion plate. In some embodiments, the insert is configured to direct a fastener at a substantially right angle relative to the fusion plate.

PRIORITY

This application claims the benefit of and priority to U.S. ProvisionalApplication, entitled “Bone Plate With Insert(s) For Optimally DirectingFasteners,” filed on Feb. 6, 2015 having application Ser. No.62/113,313.

FIELD

The field of the present disclosure generally relates to securing bonestogether. More particularly, the field of the present disclosure relatesto an apparatus for fusing and compressing bones of the human body.

BACKGROUND

A fusion bone plate implant may be utilized in conjunction with one ormore fasteners so as to generate compression and stability at a boneinterface. An implant coupled with fasteners generally serves tostabilize bones, or bone parts, relative to one another so as to promotebone fusion. In many applications, bone plates and fasteners are used tofuse bones, or bone parts, of the human body, such as bones in the foot,the ankle, the hand, the wrist, as well as various other portions of thebody. Furthermore, during the course of certain medical procedures, asurgeon may immobilize one or more bones or the bone fragments bystabilizing the bones together in a configuration which approximates thenatural anatomy. To this end, the surgeon may use fasteners to attachthe bones to a bone plate implant so as to hold the bones in alignmentwith one another while they fuse together.

SUMMARY

An apparatus is provided for fusing bones of the human body. Theapparatus comprises a bone plate which generally is a member having oneor more fixation apertures, configured to receive fasteners, and aninsert aperture. The bone plate comprises a semi-rigid material, such asa biocompatible metal or Polyetheretherketone (PEEK), possessing atensile strength suitable for immobilizing bones. A convertible insertis configured to be retained within the insert aperture. The convertibleinsert is configured to optimally direct a fastener towards a chosenpoint of purchase for fixating or compressing bones. In someembodiments, the insert is configured to direct a fastener at an obliqueangle relative to a plane of the fusion plate. In some embodiments, theinsert is configured to direct a fastener at a substantially right anglerelative to the fusion plate.

In an exemplary embodiment, an apparatus for fusing bones of the humanbody comprises a bone plate having one or more fixation apertures andone or more insert apertures; a convertible insert configured to beretained within the insert aperture, the insert being configured with atapered, counter-bored, or countersunk internal shape to convert thedirection of a fastener for fixating or compressing the bones; and oneor more fixation screws configured to be received into the one or morefixation apertures and driven into the bones so as to fixate or compressthe bones.

In another exemplary embodiment, the bone plate is comprised of asemi-rigid material, such as a biocompatible metal orPolyetheretherketone (PEEK), possessing a tensile strength suitable forimmobilizing bones. In another exemplary embodiment, the convertibleinsert is configured to be press-fit into the insert aperture. Inanother exemplary embodiment, the convertible insert is configured to bemechanically retained within the insert aperture. In another exemplaryembodiment, the insert aperture comprises a countersunk edge, theperimeter of which includes a round portion and a flat portionconfigured to orient the convertible insert to advantageously convertthe fastener direction within the bone plate.

In another exemplary embodiment, the bone plate comprises a longitudinalrib and a multiplicity of lateral ribs, the longitudinal rib providingstructural strength to the bone plate, the multiplicity of lateral ribsbeing configured to minimize contact between the implant and the bone.In another exemplary embodiment, the bone plate comprises a longitudinalrib and a multiplicity of radial ribs, the longitudinal rib inhibitingbending along a length of the bone plate, the multiplicity of radialribs being configured to minimize contact between the bone plate and thebone, each radial ribs comprising a radius of curvature.

In another exemplary embodiment, the convertible insert is an insertcomprising an aperture configured to receive a smooth headed fastener,such that the fastener is directed at an oblique angle relative to aplane of the fusion plate. In another exemplary embodiment, the obliqueangle of the fastener facilitates compressing adjacent bones together soas to encourage bone fusion. In another exemplary embodiment, the insertaperture orients the insert, such that the fastener is directed at anyangle between 0 to 360 degrees relative to the longitudinal implant axisso as to direct the fastener to an optimal point of bone purchase tosuccessfully fuse the bone parts together.

In another exemplary embodiment, each of the fixation aperturescomprises a countersunk or threaded surface configured to receive a headof the fastener, such that the fastener fixates the bone plate to thebones. In another exemplary embodiment, the convertible insert has anaperture configured to direct a fastener at a substantially right anglerelative to the fusion plate. In another exemplary embodiment, thesubstantially right angle facilitates immobilizing adjacent bone of thehuman body. In another exemplary embodiment, the substantially rightangle facilitates fixating bones across a joint.

In another exemplary embodiment, the insert aperture is configured toreceive a circular insert comprising threads configured to engage withthreads of the insert aperture. In another exemplary embodiment, thecircular insert comprises an aperture configured to receive asmooth-headed screw, such that the fastener is directed at an obliqueangle relative to a plane of the fusion plate. In another exemplaryembodiment, the oblique angle facilitates compressing adjacent bonestogether so as to encourage bone fusion. In another exemplaryembodiment, the insert threads orient the insert fastener relative to alongitudinal dimension of the fusion plate, thereby directing thefastener at an angle across a fusion site between the adjacent bones oran optimal point of bone purchase. In another exemplary embodiment, theangle ranges between substantially 0 degrees and 360 degrees relative tothe longitudinal dimension of the fusion plate. In another exemplaryembodiment, the circular insert comprises at least one engagement holeor peripheral slots configured to receive a distal protrusion of aninsert driver, whereby the distal protrusion may be engaged into theengagement feature and the insert driver may be twisted so as tosecurely attach the circular insert within the insert aperture so as todirect the compression screw at the angle across a fusion site betweenthe bones.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings refer to embodiments of the present disclosure in which:

FIG. 1A illustrates an upper perspective view of an exemplary embodimentof a bone plate with two convertible inserts and a fastener, accordingto the present disclosure;

FIG. 1B illustrates a lower perspective view of an exemplary embodimentof a bone plate with a convertible insert and fastener in which thefastener is directed primarily in line with the longitudinal plate axisand oblique to a horizontal axis, and an additional insert that directsa fasteners primarily 90 degrees to a horizontal axis according to thepresent disclosure;

FIG. 2A illustrates an upper perspective view of an exemplary embodimentof a bone plate with a convertible insert in which the fastener isoriented primarily 90 degrees to a horizontal axis.

FIG. 2B illustrates the exemplary embodiment illustrated in FIG. 2Aaccompanied by a convertible insert configured for directing thefastener to a point of purchase in the bone that is approximately inline with plate long axis and oblique to horizontal axis, compressingbone parts in accordance with the present disclosure;

FIG. 3A illustrates an upper perspective view of an exemplary embodimentof a bone plate with an elongated aperture for the convertible washer,according to the present disclosure;

FIG. 3B illustrates a lower perspective view of the exemplary embodimentof FIG. 3A in accordance with the present disclosure;

FIG. 4A illustrates an upper perspective view of an exemplary embodimentof a bone plate accompanied by a convertible insert for obliquelydirecting a fastener, according to the present disclosure;

FIG. 4B illustrates a lower perspective view of the exemplary embodimentof FIG. 4A in accordance with the present disclosure;

FIG. 5 illustrates an upper perspective view of an exemplary embodimentof a bone plate with a circular insert with an obliquely directedfastener, according to the present disclosure;

FIG. 6 illustrates an exploded view of a portion of the bone plate andthe circular insert illustrated in FIG. 5, in accordance with thepresent disclosure;

FIG. 7 illustrates top views of three different circular inserts of FIG.5 that when secured to the same implant, direct fasteners in threedifferent orientations rotated relative to the bone plate, according tothe present disclosure;

FIG. 8 is an exploded view illustrating an exemplary embodiment of aninsert driver configured to attach the circular insert to the bone plateillustrated in FIG. 5 in accordance with the present disclosure;

FIG. 9 illustrates an upper perspective view of an exemplary embodimentof a bone plate and a circular insert with an obliquely directedfastener, according to the present disclosure;

FIG. 10 illustrates an exploded view of the exemplary embodiment of thebone plate and the circular insert illustrated in FIG. 9, according tothe present disclosure;

FIG. 11 illustrates a bottom view of the exemplary embodiment of FIG. 10with the circular insert installed into the bone plate in accordancewith the present disclosure;

FIG. 12A illustrates an close-up exploded view of a portion of the boneplate and the circular insert illustrated in FIG. 10, according to thepresent disclosure;

FIG. 12B illustrates an exploded view of an upper portion of the boneplate and a lower portion of the circular insert illustrated in FIG.12A, according to the present disclosure;

FIG. 13A illustrates a top view of an exemplary embodiment of a boneplate and a circular insert in an exemplary retaining position whichdirects a fastener in a rotated orientation relative to the bone platein accordance with the present disclosure;

FIG. 13B illustrates a top view of an exemplary embodiment of a boneplate and a circular insert in an exemplary retaining position whichdirects a fastener in a rotated orientation relative to the bone plate,according to the present disclosure; and

FIG. 13C illustrates a top view of an exemplary embodiment of a boneplate and a circular insert in an exemplary position which facilitatesinsertion and removal of the circular insert from the bone plate inaccordance with the present disclosure.

While the present disclosure is subject to various modifications andalternative forms, specific embodiments thereof have been shown by wayof example in the drawings and will herein be described in detail. Theinvention should be understood to not be limited to the particular formsdisclosed, but on the contrary, the intention is to cover allmodifications, equivalents, and alternatives falling within the spiritand scope of the present disclosure.

DETAILED DESCRIPTION

In the following description, numerous specific details are set forth inorder to provide a thorough understanding of the present disclosure. Itwill be apparent, however, to one of ordinary skill in the art that theinvention disclosed herein may be practiced without these specificdetails. In other instances, specific numeric references such as “firstplate,” may be made. However, the specific numeric reference should notbe interpreted as a literal sequential order but rather interpreted thatthe “first plate” is different than a “second plate.” Thus, the specificdetails set forth are merely exemplary. The specific details may bevaried from and still be contemplated to be within the spirit and scopeof the present disclosure. The term “coupled” is defined as meaningconnected either directly to the component or indirectly to thecomponent through another component. Further, as used herein, the terms“about,” “approximately,” or “substantially” for any numerical values orranges indicate a suitable dimensional tolerance that allows the part orcollection of components to function for its intended purpose asdescribed herein.

In general, the present disclosure describes an apparatus for fusingbones of the human body. The apparatus comprises a bone plate whichcomprises a member having one or more fixation apertures and one or moreinsert apertures. The bone plate is comprised of a semi-rigid material,such as a biocompatible metal or Polyetheretherketone (PEEK), possessinga tensile strength suitable for immobilizing bones. A convertible insertis configured to be retained within the insert aperture. The insert isconfigured to direct a fastener towards an optimal point of bonepurchase for fixating or compressing the bones. In some embodiments, theinsert is configured to direct a fastener at a substantially right anglerelative to the bone plate. Active compression between bones can beaccomplished by driving the fastener through an elongated slot in theinsert ramped on one side. It will be appreciated that the fastenershall have a smooth (non-threaded) head so that this movement within theinsert slot may be achieved.

In some embodiments, the convertible insert is configured to direct afastener at a substantially oblique angle to the bone plate. Fastenersare configured to be received into the one or more fixation aperturesand driven into the bones so as to immobilize the bones. In someembodiments, the plate insert aperture is configured to receive acircular insert comprising threads configured to engage with threads ofthe insert aperture. The threads facilitate directing the insertfastener relative to a longitudinal axis of the fusion plate, in someinstances directing the insert fastener at an angle across a fusion sitebetween the adjacent bones and in some cases directing the fastenertoward an optimal point of bone purchase. In some embodiments, thecircular insert comprises at least one gripping hole configured toreceive a distal protrusion of an insert driver. Engaging the distalprotrusion into the gripping hole and twisting the insert driverfacilitates rotating the circular insert within the insert aperture soas to attach the insert securely to the plate.

FIGS. 1A-1B illustrate an exemplary embodiment 100 of a bone plate 104with a 90 degree fastener fixation insert 108 and an oblique fastenerinsert 112, according to the present disclosure. The bone plate 104comprises a generally elongate member having fixation apertures 116suitable for receiving fasteners 120. The bone plate 104 preferably iscomprised of a semi-rigid material, such as a biocompatible metal orPEEK, possessing a tensile strength suitable for immobilizing adjacentbone parts of the human body.

As best illustrated in FIGS. 3A-4B, the bone plate 104 comprises aninsert aperture 124 which is configured to receive either type offixation insert 108,112. In the embodiment illustrated in FIGS. 1A-2B,the inserts 108 and 112 are configured to be pressed into the insertaperture 124. In some embodiments, however, the inserts 108 and 112 maybe configured to be mechanically retained within the insert aperture124, such as by way of non-limiting example, through an incorporation ofthreads, recesses, tabs, notches, clips, as well as various protrudingformations, and other similar constructs.

As illustrated in FIGS. 1A-1B, the modular compression insert 112comprises a convertible insert aperture 128 which is configured toreceive a fastener 132, such that the threaded fastener 132 is directedat an oblique angle relative to a plane of the bone plate 104. Theoblique angle of the fastener 132 facilitates compressing adjacent bonestogether so as to encourage bone fusion. The fastener 132 may be anycomponent of hardware having a head configured to abut the surface ofbone plate 104 and a shaft configured to secure bones together in afixed configuration. In some embodiments, the fastener 132 may comprisea nut and bolt assembly, a pin assembly, a bone screw, or other similarfastener suitable for use in bone. In some embodiments, the fastener 132may comprise a lag screw which includes a head that is rounded ortapered coupled to a shaft having an unthreaded portion adjacent to thehead and a threaded portion that ends at a tip.

FIGS. 1A-1B show the bone plate 104 with the convertible insert 112installed into the insert aperture 124, such that the fastener 132 isdirected at the oblique angle relative to the bone plate 104, asdescribed above. Alternatively, FIGS. 2A-2B show an exemplary embodiment134 of the bone plate 104 with the modular fixation insert 108 installedinto the insert aperture 124. The insert 108 comprises a fixationaperture 136 configured to direct a fixation screw 120 at asubstantially right angle relative to the bone plate 104, as best shownin FIG. 2A. It will be recognized that this insert 108 facilitatesimmobilizing adjacent bone parts. In some embodiments, the bone plate104 and the insert 108 may be used with two or more fasteners 120 tofixate bones across a joint. It will be also appreciated that thefastener will have a smooth (non-threaded) so that lagging orcompressing of bone fragments may be achieved.

In the embodiment illustrated in FIGS. 3A-4B, the insert aperture 124comprises a countersunk edge which includes a round portion 140 and aflat portion 144 configured to orient and receive the inserts 108, 112.It will be appreciated that the round portion 140 and the flat portion144 are configured to orient the inserts 108, 112 advantageously withinthe bone plate 104. In particular, the rounded portion 140 and the flatportion 144 orient the modular compression insert 112 such that thefastener 132 is directed along a majority of the length of the boneplate 104, thereby providing greater support to the fasteners 132 andthe bones to be fixated. Further, each of the fixation apertures 116comprises a countersunk surface configured to receive a head of thefixation screw 120, such that the fasteners 120 fixate the bone plate104 to the bones.

In the embodiment of the bone plate 104 illustrated in FIGS. 3A-4B, thebone plate 104 comprises a longitudinal rib 148 and a multiplicity oflateral ribs 152. The ribs 148 and 152 serve to relieve stress on thebone plate 104 arising due to contact between the plate and the bones.The longitudinal rib 148 provides structural strength to the bone plate104 so as to substantially inhibit bending along the length of theplate. The lateral ribs 152 support the contact at the longitudinal rib148 and reduce contact between the plate and the bone.

FIGS. 5-7 illustrate an exemplary embodiment 156 of a bone plate 160coupled with a circular-shaped insert 164. The bone plate 160 issubstantially similar to the bone plate 104, with the exception that thebone plate 160 comprises an insert aperture 168 which is configured toreceive the circular insert 164. As best illustrated in FIG. 6, thecircular insert 164 comprises threads 172 configured to rotatably engagewith threads 176 of the insert aperture 168. As will be appreciated, thethreads 172, 176 facilitate screwing the circular insert 164 into theinsert aperture 168 and are configured to orient the circular insertrelative to the bone plate for a desired fastener direction. In someembodiments, however, the circular insert 164 may be configured to beretained within the insert aperture 168, such as by way of the example,through an incorporation of recesses, tabs, notches, clips, variousprotruding formations, as well as various countersunk surfaces suitablefor press-fitting the circular insert 164 into the insert aperture 168.

The circular insert 164 comprises an aperture 180 which is configured toreceive the fastener 132, such that the fastener 132 is directed at anoblique angle relative to the plane of the bone plate 160. As describedwith reference to FIGS. 1A-2B, the oblique angle of the compressionscrew 132 facilitates compressing adjacent bones together so as toencourage bone fusion. Further, the circular insert 162, as well as thethreads 172, 176, facilitates rotating the compression screw 132relative to a longitudinal dimension of the bone plate 160, asillustrated in FIG. 7. In the embodiment illustrated in FIG. 7, theinsert external threads 132 may be timed to orient the insert thefastener so that it is directed at an angle ranging betweensubstantially 0 degrees and 360 degrees relative to the longitudinaldimension of the bone plate 160. It will be appreciated that thecircular insert 162 and the threads 172, 176 facilitate directing thefastener 132 at various angles across a fusion site between adjacentbones. The fastener will have a smooth (non-threaded) so that a laggingor compressing of bone fragments may be achieved.

As best shown in FIGS. 5 and 7, the circular insert 164 comprisesgripping holes 184. In the embodiment of FIGS. 5 and 7, the circularinsert 164 comprises two gripping holes 184, although any number ofgripping holes may be incorporated into the circular insert withoutdeviating from the scope of the present disclosure. As best shown inFIG. 8, the gripping holes 184 are configured to receive one or moredistal protrusions 188 of an insert driver 192. It should be understoodthat the insert driver 192 functions as a wrench, whereby the distalprotrusions 188 may be engaged into the gripping holes 184 and then theinsert driver 192 may be twisted so as to rotate the circular insert 164within the insert aperture 168. It should be further understood,therefore, that the gripping holes 184 and the insert driver 192facilitate directing the compression screw 132 at various angles acrossa fusion site between adjacent bones, as discussed with reference toFIG. 7.

FIGS. 9-13C illustrate an exemplary embodiment of a bone plate 204coupled with a circular-shaped insert 208. The bone plate 204 issubstantially similar to the bone plate 160, with the exception that thebone plate 204 comprises an insert aperture 212 which is configured toreceive the circular insert 208. As best illustrated in FIGS. 12A and12B, the circular insert 208 comprises circumferential protrusions 216configured to rotatably engage with a groove 220 of the insert aperture212. As will be appreciated, the circumferential protrusions 216 and thegroove 220 facilitate engaging the circular insert 208 into the insertaperture 212 and are configured such that the circular insert may bepositioned in various orientations relative to the bone plate. Acountersink 224 within the insert aperture 212 maintains the circularinsert 208 fastened within the bone plate 204. In some embodiments,however, the circular insert 208 may be configured to be retained withinthe insert aperture 212, such as by way of the example, through anincorporation of recesses, tabs, notches, clips, various protrudingformations, as well as various countersunk surfaces suitable forpress-fitting the circular insert 208 into the insert aperture 212, asdescribed herein.

The circular insert 208 comprises an aperture 228 which is configured toreceive the fastener 132, such that the fastener 132 is directed at anoblique angle relative to the plane of the bone plate 204. As describedwith reference to FIGS. 1A-2B, the oblique angle of the fastener 132facilitates compressing adjacent bones together so as to encourage bonefusion. Further, the circular insert 208, as well as the circumferentialprotrusions 216 and the groove 220, facilitates directing the fastener132 at an angle relative to a longitudinal dimension of the bone plate204, as illustrated in FIGS. 13A and 13B. In the embodiment illustratedin FIGS. 9-13B, the circumferential protrusions 216 and the groove 220are configured to orient the circular insert 208, and thus the fastener132 at an angle ranging between substantially 0 degrees and 360 degreesrelative to the longitudinal dimension of the bone plate 204. It will beappreciated that the circular insert 208, the circumferentialprotrusions 216, and the groove 220 facilitate directing the fastener132 at various angles across a fusion site between adjacent bones.Moreover, the fastener 132 comprises a smooth, non-threaded portion,such that a lagging or compressing of bone fragments may advantageouslybe achieved.

As best shown in FIGS. 12A and 12B, the circular insert 208 comprisesgripping holes 232. In the embodiment of FIGS. 9-13B, the circularinsert 208 comprises three gripping holes 232, although any number ofgripping holes may be incorporated into the circular insert withoutdeviating from the scope of the present disclosure. It should beappreciated that the gripping holes 232 are substantially identical tothe gripping holes 184, described above in connection with FIG. 8. Aswith the gripping holes 184, the gripping holes 232 are configured toreceive one or more distal protrusions of a suitable wrench, such as theinsert driver 192. The distal protrusions 188 may be engaged into thegripping holes 232 and then the insert driver 192 may be twisted so asto rotate the circular insert 208 within the insert aperture 212. Itshould be further understood, therefore, that the gripping holes 232 andthe insert driver 192, or other suitable wrench, facilitate directingthe fastener 132 at various angles across a fusion site between adjacentbones, as discussed herein.

As best illustrated in FIG. 11, the bone plate 204 comprises alongitudinal rib 236 and a multiplicity of radial ribs 240. The ribs 236and 240 serve to relieve stress on the bone plate 204 arising due tocontact between the plate and the bones. The longitudinal rib 236provides structural strength to the bone plate 204 so as tosubstantially inhibit bending along the length of the plate. The radialribs 240 support the contact at the longitudinal rib 236 and reducecontact between the plate and the bone. It will be appreciated that thelongitudinal rib 236 is substantially similar to the longitudinal rib236, extending along the longitudinal dimension of the bone plate 104.Further, the radial ribs 240 are substantially similar to the lateralribs 152, with the exception that each of the radial ribs 240 comprisesa circular segment having a radius of curvature. In some embodiments,the radial ribs 240 all have the same radius of curvature. In someembodiments, the radial ribs 240 each has a unique radius of curvature.In some embodiments, each of the radial ribs 240 has a unique radius ofcurvature extending from substantially the center of the circular insert208, along the longitudinal rib 236, to the radial rib.

Moreover, it should be recognized that the bone plate 204 is not to belimited to flat plates, but rather the bone plate 204 may comprisecurvature along the longitudinal dimension of the bone plate 204,curvature along a lateral dimension of the bone plate 204, as well as acombination of curvatures along the longitudinal and lateral dimensionsof the bone plate 204. In some embodiments, the curvature may changealong the longitudinal and lateral dimensions of the bone plate as afunction of distance from the center of the insert aperture 212. In someembodiments, the curvatures along the longitudinal and lateraldimensions of the bone plate 204 are selected to match a specificsurface topology of a bone to be treated. Accordingly, it should beunderstood that the bone plate 204 may be implemented with anycombination of topological features without deviating from the spiritand scope of the present disclosure.

It is envisioned that the embodiments discussed herein may be coupledwith various surgical instruments that are configured for implanting thebone plates, inserts, and fasteners into patients. In some embodiments,the surgical instruments may include without limitation, plate trials,wires, drills, drill guides, depth gages, cup and cone reamers, screwdrivers, plate benders, and the like. It is further envisioned that thebone plates, inserts, accompanying fasteners, and the selected surgicalinstruments are to be suitably sterilized for surgeries and packagedinto sterilized containers. In some embodiments, the insert and the boneplate may be packaged in an assembled state into a first sterilecontainer, the fasteners may be packaged into a second sterilecontainer, and the instruments may be packaged into a third sterilecontainer. The first, second, and third sterile containers may then bebundled together into a single, exterior container, thereby forming aconvenient surgery-specific bone fusion implant package. In someembodiments, however, the bone plate and the insert may be packaged intoseparate sterile containers, thereby allowing a surgeon to assemble thebone plate and the insert before or during surgery. It is envisionedthat other packaging techniques will be apparent to those skilled in theart without deviating from the spirit and scope of the presentdisclosure.

While the invention has been described in terms of particular variationsand illustrative figures, those of ordinary skill in the art willrecognize that the invention is not limited to the variations or figuresdescribed. In addition, where methods and steps described above indicatecertain events occurring in certain order, those of ordinary skill inthe art will recognize that the ordering of certain steps may bemodified and that such modifications are in accordance with thevariations of the invention. Additionally, certain of the steps may beperformed concurrently in a parallel process when possible, as well asperformed sequentially as described above. To the extent there arevariations of the invention, which are within the spirit of thedisclosure or equivalent to the inventions found in the claims, it isthe intent that this patent will cover those variations as well.Therefore, the present disclosure is to be understood as not limited bythe specific embodiments described herein, but only by scope of theappended claims.

What is claimed is:
 1. An apparatus for fusing bones of the human body,comprising: a bone plate having one or more fixation apertures and oneor more insert apertures; a convertible insert configured to be retainedwithin the insert aperture, the insert being configured with a tapered,counter-bored, or countersunk internal shape to convert the direction ofa fastener for fixating or compressing the bones; and one or morefixation screws configured to be received into the one or more fixationapertures and driven into the bones so as to fixate or compress thebones.
 2. The apparatus of claim 1, wherein the bone plate is comprisedof a semi-rigid material, such as a biocompatible metal orPolyetheretherketone (PEEK), possessing a tensile strength suitable forimmobilizing bones.
 3. The apparatus of claim 1, wherein the convertibleinsert is configured to be press-fit into the insert aperture.
 4. Theapparatus of claim 1, wherein the convertible insert is configured to bemechanically retained within the insert aperture.
 5. The apparatus ofclaim 1, wherein the insert aperture comprises a countersunk edge, theperimeter of which includes a round portion and a flat portionconfigured to orient the convertible insert to advantageously convertthe fastener direction within the bone plate.
 6. The apparatus of claim1, wherein the bone plate comprises a longitudinal rib and amultiplicity of lateral ribs, the longitudinal rib providing structuralstrength to the bone plate, the multiplicity of lateral ribs beingconfigured to minimize contact between the implant and the bone.
 7. Theapparatus of claim 1, wherein the bone plate comprises a longitudinalrib and a multiplicity of radial ribs, the longitudinal rib inhibitingbending along a length of the bone plate, the multiplicity of radialribs being configured to minimize contact between the bone plate and thebone, each radial ribs comprising a radius of curvature.
 8. Theapparatus of claim 1, wherein the convertible insert is an insertcomprising an aperture configured to receive a smooth headed fastener,such that the fastener is directed at an oblique angle relative to aplane of the fusion plate.
 9. The apparatus of claim 8, wherein theoblique angle of the fastener facilitates compressing adjacent bonestogether so as to encourage bone fusion.
 10. The apparatus of claim 8,wherein the insert aperture orients the insert, such that the fasteneris directed at any angle between 0 to 360 degrees relative to thelongitudinal implant axis so as to direct the fastener to an optimalpoint of bone purchase to successfully fuse the bone parts together. 11.The apparatus of claim 1, wherein each of the fixation aperturescomprises a countersunk or threaded surface configured to receive a headof the fastener, such that the fastener fixates the bone plate to thebones.
 12. The apparatus of claim 1, wherein the convertible insert hasan aperture configured to direct a fastener at a substantially rightangle relative to the fusion plate.
 13. The apparatus of claim 12,wherein the substantially right angle facilitates immobilizing adjacentbone of the human body.
 14. The apparatus of claim 12, wherein thesubstantially right angle facilitates fixating bones across a joint. 15.The apparatus of claim 1, wherein the insert aperture is configured toreceive a circular insert comprising threads configured to engage withthreads of the insert aperture.
 16. The apparatus of claim 15, whereinthe circular insert comprises an aperture configured to receive asmooth-headed screw, such that the fastener is directed at an obliqueangle relative to a plane of the fusion plate.
 17. The apparatus ofclaim 16, wherein the oblique angle facilitates compressing adjacentbones together so as to encourage bone fusion.
 18. The apparatus ofclaim 15, wherein the insert threads orient the insert fastener relativeto a longitudinal dimension of the fusion plate, thereby directing thefastener at an angle across a fusion site between the adjacent bones oran optimal point of bone purchase.
 19. The apparatus of claim 18,wherein the angle ranges between substantially 0 degrees and 360 degreesrelative to the longitudinal dimension of the fusion plate.
 20. Theapparatus of claim 19, wherein the circular insert comprises at leastone engagement hole or peripheral slots configured to receive a distalprotrusion of an insert driver, whereby the distal protrusion may beengaged into the engagement feature and the insert driver may be twistedso as to securely attach the circular insert within the insert apertureso as to direct the compression screw at the angle across a fusion sitebetween the bones.